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. 2025 Jul 31:14:287.
doi: 10.4103/jehp.jehp_2200_24. eCollection 2025.

Technology-bAsed cardiac rehabilitation therapy (TaCT) for women: Intervention implementability, usability, engagement and acceptability in a middle-income setting

Henita J Menezes  1 , Sonia R B D'Souza  1 , Ramachandran Padmakumar  2 , Abraham S Babu  3 , Rohini R Rao  4 , Meenakshi Garg  5 , Namratha P Kotebagilu  5 , Veena G Kamath  6 , Asha Kamath  7 , Akhila Satyamurthy  3 , Shrikant Sahu  3 , Sherry L Grace  8   9
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Technology-bAsed cardiac rehabilitation therapy (TaCT) for women: Intervention implementability, usability, engagement and acceptability in a middle-income setting

Henita J Menezes et al. J Educ Health Promot. .

Abstract

Background: Despite the benefits of cardiac rehabilitation (CR), women are under-represented, especially in lower-income settings. Technology may be leveraged to tailor CR to better engage women, but this has never been tested in a middle-income country. This study assessed the implementability, usability, engagement, and acceptability of Technology-bAsed Cardiac rehabilitation Therapy (TaCT) in women with cardiovascular disease (CVD) in a middle-income country.

Materials and methods: Data from intervention arm participants in a randomized trial was analyzed. The trial was undertaken in the outpatient cardiology department of a private tertiary care center in India. The 6-month CR intervention was delivered via an app (individualized secondary prevention recommendations), website (patient education), WhatsApp (standardized behavior change promotion messages, yoga/relaxation video, support chat), and bi-weekly one-on-one phone calls with a nurse trainee (risk factor management). At the end of the intervention, participants' engagement, usability (System Usability Scale), and, acceptability (/5) of the program were evaluated using descriptive statistics.

Results: 50 women were randomized to intervention; one died and 49 (100%) were retained. Some participants faced challenges such as internet availability issues and technical glitches. There were no adverse events. Engagement was high for calls (mean = 11.6 ± 1.4/12), WhatsApp messages (mean = 34.2 ± 4.6/36 read) the website (74-151 hits/education page), and the mobile app (7.2 ± 4.2 times/patient); there were no group chat messages. Usability was rated as "excellent" (94.7 ± 5.2/100). Acceptability with the overall intervention was high (means ≥4.5/5), but was lower for information understandability, including diet and exercise recommendations.

Conclusions: Favorable implementability and acceptability, as well as excellent usability and engagement with TaCT were established. Along with favorable outcome results, this suggests that TaCT may serve as a valuable intervention to improve women's access and adherence to CR in resource-constrained environments.

Keywords: Cardiac rehabilitation; cardiovascular diseases; developing countries; good health and well-being; implementation science; technology; user-centered design; women.

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Conflict of interest statement

The authors declare that they have no competing interests.

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